For the first time in a decade, the number of emergency room visits declined in 1994, a new report states.
The largest decreases occurred in areas with mature managed-care markets, according to the report, which was released last week by the American Hospital Association.
The decline highlights the growing competition between traditional emergency departments, primary-care physicians and other types of urgent-care facilities.
In 1994, there were 90.5 million emergency room visits nationwide, according to the AHA survey. That represented a decline of 2.2% from 1993 and reversed a 10-year trend of 1% to 3% annual increases.
The Pacific region experienced the biggest drop in emergency room visits, nearly 14% from 1993 to 1994. The East South Central region, led by a sharp decrease in visits in Tennessee, was second with a drop of 5.7%. The report attributed the decline in Tennessee to the implementation of Tenn-Care, which moved most of the state's Medicaid beneficiaries into managed-care plans.
Minneapolis, which has a strong managed-care presence, reduced its emergency room usage by more than 25% from 1990 to 1993, according to the report.
"Emergency room use depends greatly on how aggressive managed-care organizations are at curtailing visits for nonurgent care," said Susan Cahn, issues analyst for the AHA's Society for Ambulatory Care Professionals, which produced the report.
According to the study, hospital emergency rooms are no longer the sole providers of emergency care.
"Emergency physicians...face stiff competition from both urgent-care providers and primary-care physicians," the report concludes. "The emergency department can expect further change as their institutions participate more fully in networks."